June 4, 2009

I have been “off the grid” so to speak for the past…oh…7 months!!! I know, I know, I’m a horrible horrible blogger. I’ve undoubtedly lost my audience. Anyway, I won’t try to catch you up on all that you’ve missed because it makes me tired to think about all that I’ve done in the past 7 months.

My third year of med school–the pinnacle of transitioning from student to doctor–is rapidly coming to an end. In a mere 2+ weeks, I’ll be considered a 4th year, sometimes referred to as a sub-I (sub-intern). One measely step away from being an actual doctor. <365 days stands between me and the initials M.D. As I attempt to hurdle over the last 2 weeks of third year (which includes catching lots and lots of babies), the prospect of applying to residency is looming over my head.

Currently, instead of blogging, I should be writing my personal statement. I have had this task in the back of my head hoping that something brilliant would come to the forefront as I procrastinated week after week. The problem is, I don’t know what exactly sets me apart from my peers. Somehow, I don’t think “Cocktail Mixologist” as a title would really catch my readers’ attention in the desired way. On some level, I think what sets me apart are my observations of patients’ individual situations that prevent them from achieving their health potential, and I’m not sure that is something that would be quite as eye-catching to residency directors as “traveled to Africa 3x and started a clinic” which is an experience some of my peers might be able to expand upon. How I feel about my patients is something that I don’t find a lot of my peers talk about, yet is not something that is tangible or “writeable.” My personal statement, it would seem, is almost too personal to write about!

Perhaps if I had done a better job of keeping up with this blog, I would have something more to write about. Sigh.

November 5, 2008

I’ve taken a hiatus from medical school. Yep, I’ve turned in my white coat for a velour tracksuit (also known as the housewife uniform). I’ve decided to take a month off and due a nursing rotation of sorts.

These past 3 months have been some of the most stressful of my life. I started third year with no problem, actually enjoying school for a change. I didn’t dread waking up every morning, and I was starting to get the hang of taking care of patients. However, throughout the past three months, I’ve waited on pins and needles for phone calls about my grandmother and about my dad’s multiple test results. I would read statistics about delirium and how 40% of people who experience delirium will die within a year. Imagine having to study about the pancreas while wondering if these terrible things you’re reading about are happening inside of your dad’s body as you read. It wasn’t easy and did not lend itself to A) wanting to study or B) concentration.

When I got news that my dad had a lesion on his pancreas, I was doing my neurosurgery clerkship. I desperately wanted to run into my general surgery resident with whom I really had a connection in order to talk about it. For various reasons, I didn’t see her for over a week since finding out the news. When I ran into her in the surgery locker room, I asked if she had a minute. The second that I blurted out that they found something on my dad’s CT scan, I burst out in tears. Her response was “as medical professionals, we’re all living on the edge–we live in fragile balance between holding it together and coming undone.” I’ll never forget that because I am now totally aware that that’s how I’ve been living. I live day-to-day trying to take care of others’ loved ones while wondering who’s taking care of my loved ones.

I could feel myself coming undone these past few months. Many times during the week, I knew I just didn’t feel like myself. I had zero concentration, I couldn’t accomplish simple tasks, and I would stare at my books as my mind wandered. At times I felt very lonely. I knew way too much about my dad’s condition and that he would certainly have surgery–even when the GI doctor told my parents otherwise. I knew that the only surgery done on the pancreas was a huge one. I still feel lonely sometimes. I know too much. I know exactly how surgery will happen. I know how they will prep him for surgery–positioning him just so, vigorously scrubbing the surgical site, setting up sterile field, all while the anesthesiologist works frantically to intubate him. I know what it’s like to make that big incision . I know that my dad will be used as a teaching example for excited residents and medical students who can’t wait to see this Whipple and don’t care that it’s my dad. I know that the resident will get to do more on this Whipple than he/she got to do on the last. i know that the medical student will get tired of retracting and that her arm might feel like it’s about to fall off but that she can’t say anything lest they want to get yelled at. I know that at the end, the surgeon will leave the room to let the resident and medical student close, and if the student is lucky, she’ll get to throw the stiches and sutures. I also know that the medical student might not have the famed suturing skills that I did 🙂

I know too much, and as much as it can be a lonely position, I also realize that it’s an honor to know so much. Every time someone from the family calls me to ask a medical question, I smile. When my aunt wanted my opinion on my grandmother’s care, I was floored. The fact that people trust me and look to me for answers is a responsibility that I really enjoy.

For now, I’m going to leave my white coat at the door, and just be my dad’s advocate. I’ll probably annoy him by making him follow the doctor’s orders. I’ll probably annoy the medical team by wanting to hear and know everything. But this is what I need to do–for my dad, my mom, and my own mental health. Time to go pack up the velour tracksuit, I’m off to Carmel tomorrow!

October 4, 2008

Sorry for the absence from the blog world. The last few days of my surgery rotation were hectic with tests and practical exams, compounded by a quick visit to see family out east and constant worry about the people I love most. Alas, I finished the rotation mostly unscathed and with more questions about my future than ever.

I started psychiatry this week. To switch from surgery to psych is kind of like switching from Biden to Palin. Skill and answers on one side, a lot of funny words and fuzzy data on the other.

Most of my patients are textbook patients. They have delusions that they are being framed by the doctors for a murder they didn’t do. Little people walk into their rooms and hand them their glasses. They hear voices all night long that keep them up. They feel misunderstood.

However, as interesting as these patients are, the patient that I am most intrigued by is a man suffering from major depression. I first noticed him when I observed a music therapy session where he picked all Simon and Garfunkel songs to create the soundtrack of his life. Unlike the other patients who created their soundtrack based on the actual song titles, this man chose the songs based on their meaning and theme. Later that evening, I had some down time and decided to sit with him. With an easy lead in…”how ’bout those Cubs”…we were off running. We talked about politics (he is a democrat who too is dumbfounded by Sarah Palin), memorable baseball games, and how to swing the “family-room” nightly TV vote in the hospital so that he could watch the debate instead of the Cubs. We talked for over an hour and it felt like mere moments. Perhaps the most interesting part of the night was when he asked me what my role was in the hospital. He thought I was a nursing student, and looked quite surprised to hear I was a medical student. (Sadly) I think he couldn’t believe that someone on the core medical team was willing to spend that much time with him.

I can’t put my finger on it, but there is something about him that is so intriguing, and I just hope with every bone in my body that he can turn this around. It’s also the first time since I’ve started this whole med school thing that I think I’ve actually made a difference in somebody’s life. His face lit up this morning when he saw me.

I guess if I had to name the song that’s playing in my soundtrack right now, it would be “Song for the Asking”

“Here is my song for the asking
Ask me and I will play
So sweetly, I’ll make you smile”

September 7, 2008

I recently started the ambulatory portion of my surgery rotation. That means that I just go to clinics for pre-op and post-op patients but don’t actually operate on any of them. This is an interesting situation for me because I work with three different physicians in three different specialties (ENT, ortho, and urology). The different personalities are fascinating, and you can tell they’re each drawn to their specialty for a reason. If I were to write a “Help wanted” ad for each specialty based on the physician I follow, it would go something like this:

_ Dr. Urology_ Must love shooting the shit with old men who can’t urinate. Being able to tolerate listening to excruciating details about the process of urinating required. Excellent skill at performing digital rectal exams a plus. Women need not apply (patients dislike discussing erectile dysfunction with young 20-something women)

-Dr. Ortho_ Do you hate spending time with patients and listening to them complain? Then this job is for you! In and out of patients room in < 5 minutes! Not very concerned if your patient is in pain? Inquire within. Punctuality not required.

_Dr. ENT_ If you get extreme satisfaction from cleaning out your own ears, imagine how satisfying it is to pull out chunks from little kids’ ears. Sure they scream and require multiple restraints to get the job done, but if you could only see the amount of ear wax you can get from a 4 year-old’s ear! Unbelievable! Must be able to tolerate snot, mucus, and many, many tears.
Needless to say, I won’t be answering any of these ads any time soon…

August 24, 2008

I know it’s been forever since I’ve posted! Neurosurgery has been a whirlwind. This weekend, though, I made a conscious effort to enjoy myself and spend time with friends, family, and that guy I live with…what’s his name again? Having been Type A personality since pre-school, when my teacher had to tell my mom that I was a leader (read bossy), I’ve never been one to play before work–not back then when my “play” was dolls and not now when my “play” is martinis.

This weekend was a rare time when I made lots and lots of plans even though I have an intimidating project due Thursday that I hadn’t started. I’ve been thinking about some of the things I’ve missed out on lately and things I’m missing out on in the future, and I just couldn’t stand to miss out on one more thing. I was unwilling to give up another girls night. I would not miss another Cubs game. Dinner on the deck on a beautiful summer night had to be done.

The outcome of all this play and no work? I feel great today. I feel like I have a life. I feel normal. Not only that, but I was able to sit down at 9:30 a.m. and not get up until 6 p.m. today with a very large chunk of work knocked out.

The truth is that this is my life. Being in school where there is literally an end date to a given part of your life can make it feel like everything else needs to be postponed until that goal is reached. I still remember being in high school and thinking, well at least when I get to college, I can start living. Then undergrad was over, and I thought, in med school, I’ll feel like an adult and really start living a normal life. Now my thoughts are that I can start living life after residency–or maybe after fellowship. Does anyone else see a flaw in this logic when your training program is 13 years long…that’s presumably 15% of my entire life. Ouch.

The stupid cliche about enjoying the ride is annoyingly true. This is it. My ride may have a few more blood-rushing hills and upside-down loops, but I have got to enjoy it because I paid good money to get on this ride 🙂

August 12, 2008

Cate recently wrote that she doesn’t think of herself as having the same body parts or internal processes as her patients. It makes sense–you put up a wall between you and the folks in the beds and on the operating tables so that you don’t lose your mind thinking about the thousands of things that can go wrong in your own body. Sometimes, though, you can’t keep that wall up. Cate came home the other night with the story of a 46 year old man she had seen that day, a father of two with a brain tumor that would allow him another year of life, if he was lucky. Then there was an older woman who was diagnosed with a brain tumor just days after the birth of her granddaughter. And that was just one day at the hospital. I started thinking about how many people’s lives are saved, lost or altered forever in that place on an average day.

One of the things Cate is struggling with now is that the doctors around her don’t show much compassion. Some of them seem to be just going through the motions (the motions of operating on the brain and spinal cord–no big deal). It seems to me that to be a good doctor you have to keep in mind that the old man in the operating room is somebody’s father, somebody’s grandfather. The newborn with hydrocephalus is somebody’s baby. The wall you put up between you and your patients has to be high enough to let you do your job with a clear head, but low enough to remind you that your job is somebody’s life…

July 31, 2008

On Saturday, I will conclude my time on General Surgery. Most of you who read this know that some might qualify me as somewhat of a “worrier.” I find ways to worry about the past, present, and future while I’m both awake and sleeping. Sometimes it feels like my world revolves about worrying–what am I currently worried about, what did I just finish worrying about, and should I be worried that I’m not worried about something I should be worried about. That being said, it’s no surprise that I started worrying about rotating through Gen Surg approximately 8 months before I was even accepted into medical school. I imagined that in the O.R., the surgeons basically turned into Hannibel Lecter and ate the tissue samples instead of submitting the specimens to pathology. Makes life easy for pathologists but hell for medical students.

Well, like many of my worries, the energy I had spent fretting about how terrible the O.R. turned out to be fruitless and unnecessary. It turns out that 9/10 surgeons were actually friendly, courteous, and enjoyable to work with. They really enjoy teaching, and they love what they do.

The other important learning point in this experience is that I’ve regained the confidence I thought I had lost. My incredibly difficult situation with my preceptor last year made me wonder if I was tough enough for medicine. Before my preceptor, I had always thought of myself as the strong, confident woman my mom and dad had raised me to be. Straight teeth, good education, and confidence–the only things a woman needs to be successful according to MrBruAl. Being nearly crippled by my preceptor had caused me to loose 2 of those 3 key tools (and according to Ryan, he was about to take out the straight teeth of my preceptor–so there!). Well good news…I’m back. My resident and attending set up a comfortable, relaxed situation for me and I took it and ran with it, and I’ll never look back. I know I’m smart. I know I truly care for my patients. And I know I can run with the best of ’em.

To Do List: Worry about Neurosurgery

I know this is a long post, but I have two more things to say:

#1 – In response to Ginger’s comment about my spindly fingers: the correct medical terminology is arachnodactyly. It’s commonly seen in people with Marfan’s syndrome (think Abe Lincoln). Luckily, I don’t have fingers–spindly or otherwise.

#2 – Sometimes I try to get a laugh out of Ryan by filling in the following blank: Today at my work, I saw/did ______ , what did you do at work today? Well, today I filled in the blank with “saw a 3 inch worm that had been coughed up by a 15 y/o” Aren’t you glad you didn’t marry a doctor almost???

July 23, 2008

#1 – You can live comfortably with 1.5 lungs (I saw half of a lung removed from a 75 year-old patient today)

#2 – 10-30% of the population has multiple spleens. The condition is known as polysplenia. Clever, huh.

Ever since I’ve started medical school (and actually all the way back in undergrad), I’ve had this ridiculous and nonsensical fantasy that the things I read in my textbooks don’t actually happen inside my body. Glycolysis in my cells? Not a chance! Vasodilation when I get hot? Never! Immune cells constantly fighting infection? Get outta here! As absurd as this may sound, I’m sure it’s a self-preservation coping mechanism. After all, any system that functions in my body can also become dysfunctional. By refusing to believe that I personally could be lumped into the general population’s statistics, I can slightly remove myself from my patients and avoid internalizing their conditions. As insensitive as this may sound, it is truly the only way to survive in medicine. From what little experience I’ve had thus far, I’ve learned that the key is to distance yourself from the patient’s medical condition but connect to the patient’s values.

So for the record, you who are reading this have a 10-30% chance of having multiple spleens while I don’t have a spleen at all!

July 20, 2008

On a number of occasions, Cate and I have discussed how, as a doctor (or a ‘doctor, almost’), she is obligated at all times by her chosen profession to help those in need of medical attention, both inside and outside of the hospital. For her, this brings to mind a tense scenario in which she is on a plane and a fellow passenger has a heart attack, stroke, or something equally unpleasant. Somebody yells out, “Is there a doctor on the plane?!” Thinking back to a room of a medical students mumbling a little something called The Hippocratic Oath, Cate shoots up out of her seat and saves the day with a portable defibrillator or feels for a pulse and informs the pilot that he can continue on to West Palm Beach as scheduled, ’cause this dude is dead. Then there is of course the understandable dread of having to give mouth to mouth to a complete stranger, or worse, having no idea what to do. Anyway, the point is that Cate uttered these words, or some version thereof:

“I will apply, for the benefit of the sick, all measures which are required […] I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.”

…and she’s been waiting for the moment when, during her “off hours,” she’d be required to act. Well, the first such moment came not three hours ago, on our way to dinner with friends. Pulling up to a stop sign, a crowd caught my eye, and I noticed that what they were gathered around was a biker, face down on the pavement, who had clearly just been hit by a car. He was moving, and as he attempted to roll over I noticed a sizable wound on his head. Cate asked me if she should try to help and I said that if she wanted to, I would pull over. After a second of hesitation, she grabbed her phone and was out the door.

Cate basically just confirmed that the man was breathing and told him not to move, and the Fire department and paramedics arrived within about one minute. When she returned to the car, she said that she hadn’t done anything. I tried to explain to her that in reality she’d done quite a lot. She’d opened that car door and run into a situation because she was obligated to do so. It would have been so easy to assume that the paramedics had been called and to keep driving. The point, as I see it, is not that she didn’t actually save somebody’s life or perform CPR. The point is that she opened that door and ran down the street to make herself available to somebody in need. In the end, I think it was a nice reminder of what this med school madness is all about.